[104-10222-10040.pdf — page 72]
# DESIGNATION OF BENEFICIARYUNPAID COMPENSATION OF DECEASED CIVILIAN EMPLOYEE## INFORMATION CONCERNING THE EMPLOYEE:NAME: SHAW Robert TylerDEPARTMENT OR AGENCY IN WHICH EMPLOYED:Department of State Foreign Service Mexico CityI, the employee identified above, canceling any and all previous Designations of Beneficiary heretofore made by me, do now designate the beneficiary or beneficiaries named below to receive any UNPAID COMPENSATION due and payable under existing law after my death. I understand that this Designation of Beneficiary relates solely to Unpaid Compensation as defined in section 3 of the act of August 8, 1950, Public Law 636, and in nowise will affect the disposition of any benefit which may become payable under the Retirement Act applicable to my Government service. I further understand that this Designation of Beneficiary will remain in full force and effect, unless or until canceled by me in writing, so long as I am continuously employed in the above department or agency.## INFORMATION CONCERNING THE BENEFICIARY OR BENEFICIARIES:| Type or print first name, middle initial, and last name of each beneficiary | Type or print address of each beneficiary | Relationship | Share to be paid to each beneficiary || --------------------------------------------------------------------------- | ----------------------------------------- | ------------ | ------------------------------------ || JANET LEE SHAW                                                              | 909 N. CAMPBELL AVE. TUCSON, ARIZONA.     | WIFE         | ALL                                  ||                                                                             |                                           |              |                                      ||                                                                             |                                           |              |                                      ||                                                                             |                                           |              |                                      ||                                                                             |                                           |              |                                      |I hereby direct, unless otherwise indicated above, that, if more than one beneficiary is named, the share of any deceased beneficiary shall in my preference me shall be distributed equally among the surviving beneficiaries, or entirely to the survivor. I understand that this Designation of Beneficiary shall be void if none of the designated beneficiaries is living at the time of my death.I hereby specifically reserve the right to cancel or change any designation of beneficiary at any time in the manner and form prescribed by the Comptroller General of the United States, and without knowledge or consent of the beneficiary.3-27-63WITNESSES TO SIGNATURE:Madeline Little 1114 Ellen Ave. Falls Church, Va.Vern B. Shire 206 1st NWPRINT OR TYPE NAME AND ADDRESS OF EMPLOYEERobert T Shaw909 Campbell AveTucson, ArizonaTHIS SPACE RESERVED FOR RECEIVING DATA OF EMPLOYING AGENCYPER/EMDMAR 27 1963